Occlusion clip and applicator

ABSTRACT

An occlusion clip is disclosed that comprises an occlusion portion having an upper single element occlusion member having proximal and distal upper member ends and a lower single element occlusion member having proximal and distal lower member ends. The lower single element occlusion member and the upper single element occlusion member combine to define an occlusion member plane. The occlusion clip further comprises a spring portion having a torsion spring connecting the proximal upper member end to the proximal lower member end. The torsion spring has a spring height dimension in the occlusion member plane perpendicular to the upper and lower single occlusion members and is adapted to bias the upper and lower single element occlusion members toward a closed position wherein the upper single element occlusion member is in force contact with the lower single element occlusion member.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present invention is a continuation-in-part of U.S. application Ser.No. 10/626,966, filed Jul. 25, 2003, which is incorporated herein byreference in its entirety.

BACKGROUND OF THE INVENTION

The present invention relates generally to mechanical devices used insurgical procedures to occlude a vessel or duct, and more particularly,to an instrument that can apply a pre-formed, spring-loaded clip usedduring surgery to clamp around a vessel or duct, such as cystic duct orcystic artery, and thereby obtain homeostasis or occlusion.

Those skilled in the art will appreciate that the use of clips forhomeostasis or ligation during surgical procedures is well known. U.S.Pat. Nos. 4,976,722 and 4,979,950 for example, described prior art clipsthat are formed of titanium wire. Prior to use, these clips are“U-shaped” with a rectangular cross-section. Application of these priorart clips is normally effected by means of a crushing action produced bya clip applier, such as that disclosed in U.S. Pat. No. 5,030,226. Suchcrushing action permanently deforms the clips, making them difficult toremove or re-position. Another problem with crush clips is that vesselsand tissue often shrink after occlusion owing to the onset of necrosis,for example. Because these type clips have no means for compensating forshrinking tissue, they lose their occlusion properties.

Numerous spring clips have been developed for occluding tissue. U.S.Pat. Nos. 4,966,603, 4,274,415, 5,833,700 and 6,350,269 discloseexamples of spring clips. One problem with the clips described in the'603, '415, and '700 patents is that the occlusion force exerted by theclips approaches zero as the opposing occlusion members come intocontact. Thus, for very thin tissue, the clips supply nearly zeroocclusion force.

Other problems are presented by the clip of the '269 patent. For examplethe clip of the '269 patent is too wide for many intricate proceduresand its configuration is difficult to manufacture. In addition, thisclip is difficult to remove under laparoscopic conditions.

Some spring clips, such as those clip described in U.S. Pat. No.4,556,060, are designed for placement on tissue in the surgical field byhand. Other clips, such as that described in U.S. Pat. No. 4,274,415,are applied using applicators that are suitable for use in open surgerybut not for laparoscopic surgery. One applicator that is suitable foruse in laparoscopic surgery is the applicator disclosed in the '269patent. The clip and applicator combination of the '269 patent haveseveral problems, however. For example, the clip has a narrow proximalend and the feed track in the clip holder is relatively wide. Thiscauses the clip stack to kink, which causes excessive friction duringclip feed. This can result in the clip pusher slipping over clips andclips jamming. Also, the jaws of the applicator are necessarily wide inorder to accommodate the wide distal end of the clip. This does notallow adjacent clips to be placed in close proximity as is oftenrequired in delicate procedures. Another disadvantage of the '269 systemis that surgeons are accustomed to viewing clips as they are beingapplied. Crush clips, for example, are fully visible before crushing.Viewing of the clip during application in '269 is limited to the view ofa small portion of the clip through one of two small windows in thejaws. Yet another problem is that the applicator described in '269patent uses a sacrificial clip to push the last usable clip onto thejaws for application. The sacrificial clip remains in the applicator,unusable, since there is no reliable means to push it out. Sometimes,the pusher clip is partially fed into the jaws, which causes the jaws tobecome attached to the tissue with no way to extricate the clip and freethe jaws. Finally, resetting the applicator to the initial state so thatthe applicator is ready to place a second clip is often a problem.

What is needed is a simple-to-manufacture, easy-to-remove, narrow springclip that maintains a substantial occlusion force to the occlusionmembers of the clip when they are at or near the closed position so thatsmall vessels and ducts can be adequately occluded.

SUMMARY OF THE INVENTION

An exemplary embodiment of the present invention provides an occlusionclip comprising an occlusion portion having an upper single elementocclusion member having proximal and distal upper member ends and alower single element occlusion member having proximal and distal lowermember ends. The lower single element occlusion member and the uppersingle element occlusion member combine to define an occlusion memberplane. The occlusion clip further comprises a spring portion having atorsion spring connecting the proximal upper member end to the proximallower member end. The torsion spring has a spring height dimension inthe occlusion member plane perpendicular to the upper and lower singleocclusion members and is adapted to bias the upper and lower singleelement occlusion members toward a closed position wherein the uppersingle element occlusion member is in force contact with the lowersingle element occlusion member. The occlusion clip may also comprise aclip guide portion having an upper clip guide attached to the distal endof the upper single occlusion member and a lower clip guide attached tothe distal end of the lower single occlusion member. The upper clipguide includes a first planar member having a top upper guide surfaceand an engaging bottom upper guide surface. The first planar member isperpendicular to the occlusion member plane when the upper and lowersingle occlusion members are in engagement. The lower clip guideincludes a second planar member having a bottom lower guide surface andan engaging top lower guide surface. The second planar member isparallel to the first planar member when the upper and lower singleocclusion members are in engagement.

Other features and advantages of the present invention will be readilyapparent to those skilled in the art upon a reading of the followingdisclosure when taken in conjunction with the accompanying drawings

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of an applicator in an un-stroked state accordingto an embodiment of the invention.

FIG. 2 is a side view of an applicator in a stroked state according toan embodiment of the invention.

FIG. 3 is a side view of an occlusion clip according to an embodiment ofthe invention.

FIG. 4 is a plan view of an occlusion clip according to an embodiment ofthe invention.

FIG. 5 is an end view of an occlusion clip according to an embodiment ofthe invention.

FIG. 6 is a cross sectional view of an occlusion clip according to anembodiment of the invention.

FIG. 7 is an isometric view of an occlusion clip according to anembodiment of the invention.

FIG. 8 is an isometric view of an occlusion clip according to anembodiment of the invention wherein the clip is applied to a vessel.

FIG. 9 is a cross section of the handle of an applicator according to anembodiment of the invention.

FIG. 10 is a longitudinal cross section of the distal section of anapplicator according to an embodiment of the invention.

FIG. 11 is a longitudinal cross section of the distal section of anapplicator according to an embodiment of the invention wherein the jawsare in a closed position.

FIG. 12 is a longitudinal cross section of the distal section of anapplicator according to an embodiment of the invention when theapplicator is in a fully stroked position.

FIG. 13 is a cross section of the jaw actuator tube and the clip holderof an applicator according to an embodiment of the invention.

FIG. 14 is a cross section of the jaw actuator tube and the rotator ofan applicator according to an embodiment of the invention..

FIG. 15 is a plan view of the jaw of an applicator according to anembodiment of the invention with a partially stroked clip.

FIG. 16 is a plan view of the jaw of an applicator according to anembodiment of the invention with a fully stroked clip.

FIG. 17 depicts a clip remover and an occlusion clip according to anembodiment of the invention wherein the clip remover is not engaged.

FIG. 18 depicts the clip remover and clip of FIG. 17 wherein the clipremover is engaged.

FIG. 19 is a cross-section of the clip holder and follower of anapplicator according to an embodiment of the invention.

FIG. 20 is a section view of a rotator portion of an applicatoraccording to an embodiment of the invention.

FIG. 21 is a side view of a follower that may be used in applicatorsaccording to embodiments of the invention.

FIG. 22 is a plan view of a sheet member used to produce the follower ofFIG. 21.

FIG. 23 is a side view of the jaws of an applicator according to anembodiment of the invention.

FIG. 24 is an end view of the jaws shown in FIG. 23.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a simple spring action surgical clip andan instrument to apply it. The clip may be made from a single piece oftitanium alloy wire. It has single element occlusion members connectedby a single torsion spring or connecting coil that biases the memberstogether for occluding tissue after the clip has been opened forplacement. The clip may be pre-formed so that in its equilibrium or nearequilibrium state, it can be easily placed within the surgical fieldthrough a trocar cannula of 5 mm diameter or less. After the instrumentcontaining one or more of the clips is inserted into the cannula in thevicinity of the tissue to be clamped, the clip is advanced distally,staying longitudinally aligned because of the narrow opening in the clipholder. As the clip enters the jaws of the applicator, the occlusionmembers of the clip are spread such that they pass axially over thejaws, thus increasing the tension in the connecting coil. With thetissue clamped between the jaws, the clip is further urged distallyuntil the clip guides at the distal end of the occlusion members reachthe release openings in the jaws, at which point the restoring forceexerted by connecting coil forces the clip arms back toward theequilibrium position so that they can engage the tissue to be occluded.When the applicator jaws are opened, the tissue with the clip clampedthereon is detached from the instrument.

The clip width of the present invention is determined by the width ofthe wire used to form the clip. Other than the clip guides at the distalend of each occlusion member, which can be designed to be quite small,the clip width is equal to the wire diameter for clips formed fromcircular wire. For comparison, the clip described in the '269 patent ismore than 5 wire diameters wide at the distal end. To control theplacement of the clip of the '269 patent, it is required that the jawsbe even wider, making the device unusable for small delicateapplications. Compounding the size issue, except for small windows ineach jaw, the large clip is hidden from the surgeon's view duringplacement. The clip and placement instrument of the present invention isusable in much smaller spaces and the placement instrument provides formuch better visibility during the placement process.

The applicator of the current invention employs a simple, inexpensiveclip follower that allows all the clips in the applicator to be used. Itis designed such that it will not exit the clip holder and become stuckin the jaws. As a further advantage, the applicator of this inventionminimizes the reset force, which results in a lower trigger pull force.

The invention will now be described in more detail. A surgical occlusionclip according to an embodiment of the invention includes two singleelement occlusion members joined by a bias structure, most simply asingle torsion coil, or a portion of a single torsion coil, all lying inthe same plane. Each occlusion member of the clip includes an enlargedclip guide section, the purpose of which is to control the clipthroughout the placement process. The clip is integrally formed from asingle length of wire with the clip guides formed on the wire by coilingor other similar processes. The clip can be manufactured using wire ofrectangular, circular or other constant cross section shapes. In anillustrative embodiment, the wire may have a maximum thickness in arange from about 0.01 to about 0.05 inches (10 to 50 mils). In aparticular embodiment, the wire has a circular cross section with adiameter in the range of 0.02 to 0.04 inches (20 to 40 mils) and is madefrom an implantable grade titanium alloy. The outside diameter or heightof the torsion spring—and hence its inside dimension—increases as theocclusion members are separated. The clip is formed and can beheat-treated in such a way that it provides a clamping force of at least0.20 pounds between the occlusion members when the clip is fully closed.Owing to the way in which the torsion spring is wound, the coil becomesslightly smaller as the occlusion members move toward the closedposition. Conversely, the torsion spring grows slightly as the clip isopened.

In the applicator of the present invention, the clips described aboveare held, in a partially open state in contact with each other,end-to-end, in a clip holder, a component of the applicator. The clipholder comprises two parallel rails separated by a width nominallylarger than the clip width. One clip guide rests on the top of the railswith the other clip guide on the bottom such that the clip is held in apartially open state by the thickness of the material of the clip holderrails. The opening between the rails is only slightly larger than theclip width but is not as wide as the width across the clip guides sothat the clip can be moved down the length of the clip holder withlittle side-to-side movement, always remaining in the partially openedstate. An inverted U-shaped reciprocating rod equipped with clip guideengagement fingers moves the clips distally toward the jaws with minimalfriction. The clip holder is anchored relative to the jaw actuator in arotator which is attached to a pistol grip handle.

A clip follower engages the last clip and, when the clip holder is fullyloaded, is engaged by the proximal-most clip push fingers. The clipfollower allows the ejection of all clips loaded in the clip holder suchthat there is no need to leave a unused clip in the applicator, whichmay be a disposable device.

Two articulated jaws are attached to the distal end of the clip holder.The jaws have two rectangular sections the openings of which buttpivotally together against the rectangular section of the clip holdersuch that as the clip is urged distally. One clip guide enters theinterior of the rectangular section of one jaw and the other clip guideenters the interior of the rectangular section of the other jaw thusretaining control of the clip against side-to-side movement or closure.Depending upon the thickness of the jaw material and the tissuethickness, the clip may be further opened at the transition between theclip holder and the jaws. A release opening is formed at the distal endof each jaw such that the clip guides of the clip are no longerconstrained by the jaws upon the clip reaching the distal end, thus theclip closes about the tissue and compresses the tissue because of thetension stored in the coil of the clip. The jaws are formed in an openframe arrangement so that the clip is totally visible throughout theplacement process thus eliminating the viewing windows of the prior art.Additionally, the jaw width is only slightly wider than the clip, makingthe clip very useable in small narrow spaces.

An actuator is operably connected to the jaws. The actuation of whichmoves the jaws between a first position in which the jaws are open and asecond position in which the jaws are closed.

Upon release of the activating trigger a reset spring returns the jawactuator and the clip pusher to their initial positions, the clip stackbeing then one clip shorter. The clip pusher is formed in an invertedU-shape with clip engagement fingers on either side so that the clippusher need only clear the clip guides while resetting, not the largertorsion spring as in the prior art. This significantly lessens thereturn force requirement of the reset spring and lowers the spacerequirement for containing the mechanisms.

Referring now to the drawings, and particularly to FIGS. 1 and 2, anocclusion clip applicator is shown and generally designated by thenumeral 10. Applicator 10 includes a body or handle subassembly 11 and arotator subassembly 13.

Referring to FIG. 9, the handle subassembly 11 comprises two handlehalves 18 a, one of which has been removed to allow the internalcomponents of the handle subassembly 11 to be viewed. A distallyextending handle projection 17 a is integrally formed with each of thehandle halves 18 a. When the handle halves 18 a are joined, theseprojections 17 a form a cylinder extending distally from the joinedhalves 18 a. The two handle halves 18 a fit together in a welded orpress-fit fashion and house a jaw actuator and a clip actuator. The jawactuator comprises first pusher 23, first pusher spring 25 and secondpusher 34. The clip actuator comprises clip cylinder 22 and cylinderspring 32. A lever 21 connects to both the clip actuator and the jawactuator tand to trigger 12 and rotates about axis 31 when urged torotate by movement of the trigger 12. The trigger 12 rotates about apivot 29 under the pull force of the user's hand. A torsion spring 24 isattached to lever 21, abuts handle half 18 a, and provides a reset forcefor both actuators.

FIGS. 14 and 20 depict the rotator subassembly 20, comprising tworotator halves 13 a (one of which has been removed to allow the interiorcomponents of the rotator subassembly to be viewed), a clip holder 71, ajaw actuator tube 14, a jaw actuator tube spring 26, a clip push rod 50and jaws 15 and 16. A plurality of clips 40 may be positioned within theclip holder 71 as will be discussed in more detail hereafter. Therotator half 13 a contains a clip holder anchor pin 28 and a jaw pushtube stop 27. The two rotator halves 13 a may be held together byfriction from alignment pins 29 a in one of the rotator halves 13 a andmating sockets (not shown) in the other rotator half or by welding orbonding the two halves 13 a together.

The proximal end of the joined rotator halves 13 a is received over thecylindrical handle extensions 17 a to join the rotator subassembly 20 tothe handle subassembly 11. The subassemblies 11, 20 may be lockedtogether by interlocking tabs. The rotator subassembly 20 is configuredso that it can be rotated about its longitudinal axis relative to thehandle subassembly 11.

Now turning to FIGS. 3-8, depicting various views of a clip 40 accordingto an embodiment of the present invention. The clip 40 is describedbelow relative to the three axes L, P1, and P2 shown in FIG. 7.Longitudinal axis L defines the longest portion of clip 40. Verticalaxis P1 is perpendicular to axis L and together with L defines avertical plane L-P1 that contains torsion spring coil 41. Lateral axisP2 is perpendicular to the vertical plane L-P1. Lateral axis P2 andlongitudinal axis L together define a horizontal plane L-P2. It will beunderstood by those of ordinary skill in the art that the terms lateral,vertical and longitudinal are intended to describe a space relative tothe clip 40 and not to indicate a fixed position relative to the spacein which the clip 40 is to be positioned.

FIG. 3 shows a clip 40 divided into a torsion spring section 46, anocclusion member section 47 and a clip guide section 48. In thisembodiment, the torsion spring section 46 comprises a single wire loop41 connected to the occlusion member section 47. One end of the torsioncoil 41 is connected to a single element upper occlusion member 42, andthe opposite end of the torsion coil 41 is connected to a lower singleelement occlusion member 43. The upper occlusion member 42, the torsionspring 41, and the lower single element occlusion member 43 are allcentered within the vertical plane L-P1. When the clip 40 is in theclosed configuration shown in FIG. 3, the height H_(O) of the occlusionportion 47 in the vertical plane L-P1 is no more than two times thediameter of the wire used to form the clip 40. In the closedconfiguration, the single element occlusion members 42, 43 aresubstantially parallel. FIG. 4 depicts a plan view of clip 40. The widthW_(O) of the occlusion section 47 in the plane L-P2 is equal to thediameter of the wire used to form the clip 40.

The clip guide section 48 comprises the clip guides 44, 45 which areconnected to the upper and lower occlusion members 42, 43 respectively.The clip guides 44, 45 may be formed as planar members having anengagement surface that is approximately coplanar with the innerengaging surfaces of the occlusion members 42, 43. The clip guides mayhave a proximal edge 56 that is configured for engagement by the fingers51 a, 51 b of a clip push rod 50 of the applicator 10 as will bediscussed hereafter. As will also be discussed, the width W_(G) of theclip guides 44, 45 is established so that the lateral edge portions 57of the clip guides as seen in FIG. 5 and proximal edge 56 as shown inFIG. 6 can engage the rails 72 a, 72 b of the clip holder 71. FIG. 5shows a distal end view of the clip 40 and FIG. 6 depicts a section viewof the clip 40 through the torsion coil 41. FIG. 8 shows the clip 40with the occlusion members 42, 43 occluding a vessel 49.

FIGS. 10, 11, and 12 are longitudinal cross sections of the distal endof the applicator 10. FIG. 10 depicts the applicator 10 in the home, orready-to-fire, position. In this position, clips 40 a, 40 b, and 40 care in proximal-to-distal contact with each other and the proximal-mostclip 40 a is positioned adjacent the entrance to the jaws 15, 16.

FIG. 13 shows a perpendicular cross section taken across jaw actuatortube 14. The clip holder 71 has a U-shaped cross-section with opposingfirst and second rails 72 a, 72 b extending inward into the center ofthe U. Clips 40 are positioned in the clip holder 71 so as to be heldslightly open by the rails 72 a ,72 b. The rails 72 a, 72 b are engagedonly by the lateral edge portion 57 of the clip guides 44, 45 of theclips 40. The slot 73 formed between the rails 72 a, 72 b is onlynominally larger than the width W_(O) of the occlusion clip section 47and the torsion spring 46 so that the clips 40 are guided straight alongtheir axis L with little side-to-side movement. To minimize theside-to-side movement of the clips 40, the slot 73 may have a width thatis less than about 0.001 inches greater than the occlusion section widthW_(O) of the clip 40. Thus, for clips formed from 0.030-inch wire, theslot 73 may have a width in a range of about 0.0315 to about 0.0305inches.

The clip push rod 50 comprises fingers 51 a, 51 b attached to anelongate shaft 59. The fingers engage the upper clip guide 44, andrestoring spring 55, which contacts the inside surface of the jaw pushtube 14 and biases the fingers 51 a, 51 b into engagement with the upperclip guide 44. The shaft 59 of the clip push rod 50 is attached at itsproximal end to the clip cylinder 22. The clip push rod 50 is configuredso that when the clip push rod is moved proximally, the fingers 51 a, 51b are dragged over the clips 40 remaining in the clip holder 71. As theypass over the clips 40, the fingers 51 a, 51 b and the shaft 59 aredeflected upwards to allow the fingers 51 a, 51 b to clear the clips 40.A compressible spacer (not shown) may be positioned above the shaft 59of the clip push rod 50 to keep the fingers 51 a, 51 b in engagementwith the clips 40.

The clip holder 71 is attached to upper and lower jaws 15, 16 at a jawpivot 73. The jaw actuator tube 14 is attached to the jaws 15, 16 atattachment points 81, 82. The clip push rod 50 engages the upper clipguide 44 of each clip behind the proximal-most clip 40 a and a clipfollower 60 via fingers 51 a, 51 b. Although only three clips 40 areshown in FIGS. 10, 11, and 12, it will be understood that the applicatormay be sized to accept any number of clips 40.

FIG. 19 is a cross-section of the clip holder 71 showing the follower60. The follower 60 may be a solid or hollow body or, as will bediscussed below, may be an elongate member bent to a desired shape. Thefollower 60 is configured with rail slots 62, 63 so that the follower 60may be slidably mounted to the clip holder rails 72 a, 72 b. Thefollower 60 has a clip engaging surface 61 that engages the distal endof the distal-most clip 40 c. The follower 60 may be attached to or maybe configured to be engaged by the clip push rod 50,

FIG. 11 shows the proximal end of the applicator 10 in an intermediateconfiguration wherein the trigger 12 has been pulled proximally causingthe first pusher 23 and second pusher 34 to move in the proximaldirection. This causes the jaw actuator tube 14 to compress the jawactuator tube spring 26 (first pusher spring 25 is less compressedbecause of its higher spring constant) and move proximally, therebyforcing causing the jaws 15, 16 to rotate about the jaw pivot 73 to aclosed position.

FIG. 12 depicts the applicator 10 in a configuration where the trigger12 is reaching its fully stroked position. In this configuration, theproximal-most clip 40 a is pushed over the jaws 15, 16 by the secondclip 40 b, which has been urged proximally by the clip push rod 50 andby the distal-most clip 40 c, which has in turn been urged proximally bythe clip push rod 50 and by the follower 60.

FIGS. 15 and 16 are plan views of the upper jaw 15 and a clip 40. Itwill be understood that the lower jaw 16 is simply a mirror image of andhas identical features to the upper jaw 15. The jaw 15 has a jaw groove91 flanked by entrance ramps leading to two jaw rails 95 a, 95 b. Thejaw groove 91 terminates at its proximal end in a cut-out 92 sized toallow the clip guides 44, 45 to be passable therethrough. As was theslot 73 formed between the rails 72 a, 72 b of the clip holder 71, thejaw groove 91 is sized to be nominally larger than the width W_(O) ofthe occlusion members 42, 43 and torsion spring coil 41 of clip 40. Thisallows the clip 40 to be moved proximally through the jaw groove 91 withlittle side-to-side motion. To minimize the side-to-side movement of theclips 40, the jaw groove 91 may have a width that is less than about0.001 inch greater than the occlusion section width W_(O) of the clip40. Thus, for clips formed from 0.030-wire, the jaw groove 91 may have awidth in a range of about 0.0305 to 0.0315 inches

As the clip 40 is moved onto and along the jaws 15, 16, the lateral edgeportions 57 of the clip guides 44, 45 engage opposite sides of theentrance ramps and jaw rails 95 a, 95 b, which keeps the clip 40 in anopen state until the clip moves further distally as depicted in FIG. 16.When the clip guides 44, 45 reach the fall through cut out 92, they arereleased from the jaw rails 95 a, 95 b. The biasing force exerted by thetorsion spring coil 41 causes the occlusion members 42, 43 to movetoward a closed position. Any tissue 49 positioned between the occlusionmembers 42, 43 is engaged and occluded by the occlusion members as shownin FIG. 8. Because it is passed over the outside surface of the jaws 15,16, the clip 40 is clearly visible throughout the transition over thejaws 15, 16 to the detached occluding condition.

FIGS. 23 and 24 illustrate an embodiment of the invention in which thejaws 15, 16 of the applicator includes tissue stops 300 and 301. Thetissue stops 300, 301 are configured so that when a vessel 49 to beoccluded is placed between the jaws 15, 16, the tissue stops 300, 301abut the vessel 49 and position it so that the vessel is properlypositioned within jaws 15, 16. This assures that the occlusion members42, 43 of the clip 40 properly compress the vessel 49 and that theeyelet formed by the coil 41 of the clip is proximal to vessel 49. Thisassures that the vessel 49 is fully occluded.

Referring now to FIGS. 17 and 18, an embodiment of the inventionincludes an instrument and method for removing and manipulating theclips 40 described above. A remover instrument 100 comprises first andsecond clip remover jaws 181, 182, which are shown on either side of thetorsion spring coil 41 of a clip 40 in its closed or occludingcondition. The first remover jaw 181 has an engagement member 183extending laterally from its proximal end. The engagement member isgenerally frusto-conical and is sized and tapered such that it will fitpart way into the interior space 49 of the torsion spring coil 41,contacting the inside surface approximately midway between the face 185of the first engagement member 183 and the jaw 181. Inward movement ofthe second clip remover jaw 182 forces engagement member 183 into theinterior space 49 of the torsion spring coil 41.

The remover jaws 181, 182 may be attached to any suitable graspingmechanism that allows the remover jaws 181, 182 to be manipulated so asto selectively engage and disengage the engagement members 183. When theengaging member is made to engage within the interior space of thetorsion spring coil 41 of a clip 40, the engaging member 183 comes intocontact with the torsion spring coil 41. The tapered engaging member 183forces the torsion spring coil 41 to become larger, thus opening theclip 40 as shown in FIG. 18. This allows the clip 40 to be removed fromany tissue that was occluded by the clip 40.

In some embodiments of the invention, the follower may be formed from anelongate planar member bent to a desired shape. FIG. 20 is a side viewof an exemplary version of such a follower 200 that provides theadditional benefit of preventing inadvertent proximal movement of theclips 40 in the clip holder 71. The distal end of the follower 200 isdivided into four portions 201, 202, 203, 204 that are bent to form anS-shape. The upper-most portion of the follower 200 is the clip pushengagement portion 201 which has a distal end 209 that is configured forengagement by the clip push fingers 51. The follower 200 is shaped sothat when the follower is positioned in the clip holder 72, the clipengagement portion 201 is above the clip holder rails 72 and the outeredges of the lower surface 207 of the clip engagement portion 201 engageand slide along the clip holder rails 72. The S-shape of the follower200 positions the third follower portion 203 below the clip holder rails72 when the follower 200 is installed in the clip holder 72. The outeredges of the upper surface 208 of the third follower portion 203 engageand slide along the lower surface of the clip holder rails 72. The firstand third follower portions 201, 203 are connected by the secondfollower portion 202, which is narrowed so that it will pass between theclip holder rails 72.

The follower 200 has a long tail section formed by three straightfollower portions 204, 205, 206. This tail section extends distally fromthe S-shaped forward section of the follower 200. The tail section isbent downward to provide a biasing and movement resisting force when thefollower 200 is installed in the clip holder. The follower 200 has afirst straight section 204 that is substantially horizontal. This isconnected to a second straight section 205 that is angled slightlydownward. The straight section 205 connects to long tail section 206that is angled downward even further. The tail section 206 is configuredto contact the bottom of the clip holder 71 to provide friction againstproximal movement of the clip stack during reset of clip pusher 50.Sections 205, 206 also provide a spring force between the follower 200and clip holder 71.

The follower 200 may be formed from any suitable bendable but resilientmaterial, such as a thin metal sheet. FIG. 21 shows a sheet metal layoutof the elongate member used to form the follower 200 prior to its beingbent into the form shown in FIG. 20.

It is desirable that a significant force exists between the upper andlower occlusion members 42, 43 at and near the closed position. Somemesentery arteries and veins, for example, are quite small but oftenrequire occlusion. Clips that exhibit little or no preload force (i.e.,force in the closed position) cannot adequately occlude such vessels.Winding torsion spring coil 41 around a dowel and transitioning the endsof the torsion spring coil 41 into occlusion arms 42, 43 will result inlittle or no preload. However, a significant preload can be imparted bya variety of mechanical means such as distorting torsion coil 41 so asto establish a teardrop shape such as that shown in FIG. 3. The preloadforce imparted into the occlusion section 40 is offset by the forcecaused by the additional stress stored in the torsion coil 41.

In an alternative approach, the occlusion members 42, 43 can be twistedor distorted slightly out of line so that the occlusion members 42, 43are no longer coplanar and can be rotated passed one another. For someembodiments and uses, the torsion coil 41 may be adequately pre-stressedby rotating the occlusion members 42, 43 passed one another by at least20 degrees, then returning the occlusion members 42, 43 to a nearparallel state and re-twisting the occlusion members 42, 43 so that theylie over and engage one another as shown in FIG. 3. This process storesa substantial preload force between occlusion members 42, 43, which isagain offset by torsion spring forces arising from the additional stressin the torsion spring coil 41.

Yet another alternative is to form the coil 41 so as to be open at thetransition points to the occlusion members 42, 43 but with the distalends of members 42, 43 touching. Applying radial forces to the top andbottom of the coil 41 while holding the distal ends of occlusion members42 and 43 together then closes the opening in the coil 41, engendering apreload between occlusion members 42, 43.

Because implantable grade titanium alloy, 6A1-4V ELI, is generallydelivered in an annealed state, the preload force can be furtherincreased by heat treatment. In one embodiment, the formed clip isheated to a temperature just below the transition temperature (1725degrees Fahrenheit for example) for fifteen minutes in a vacuum oven,purged with argon until the sample is cooled, reheated to 900 degreesFahrenheit for four hours, and purged with argon until cool. A certainamount of reforming may be required owing to heat distortion. Thetemperature, heating time and environment can be varied to yield varyingpreload forces.

As previously noted, the applicator 10 is especially constructed for usein laparoscopic surgery wherein the applicator 10 must be insertedthrough as small an opening as possible in the patient's body althoughit can be readily used for open procedures.

It will be appreciated that a method of operating the applicator 10 mayinclude:

-   -   Loading a plurality of occlusion spring clips 40 in the clip        holder 71;    -   Compressing trigger 12 until jaws 15 and 16 are just closed;    -   Inserting jaw actuator tube 14 into a cannula;    -   Releasing trigger 12 such that the jaw actuator tube 14 resets        to the initial state;    -   Maneuvering the jaws 15, 16 to place tissue 49 therebetween; and    -   Compressing trigger 12 until clip 40 is forced out of the clip        holder and over the jaws 15, 16 to be ejected through the jaw        slot 91 and cut-out 92.        It will be understood that the clips 40 may be loaded into the        clip holder 71 without consideration to any up or down clip        orientation since the clips are symmetric in that regard. Either        clip guide 44, 45 can be oriented toward clip push rod 50. This        symmetry eliminates orientation mistakes in the manufacturing        process.

Thus, it is seen that the applicator 10, clip 40 and methods of theinvention readily achieve the objectives and advantages delineated aboveas well as those inherent therein. While certain preferred embodimentsof the invention have been illustrated and described for purposes of thepresent disclosure, numerous changes in the arrangement and constructionof parts and steps may be made by those skilled in the art, whichchanges are encompassed within the scope and spirit of the presentinvention.

Many embodiments and adaptations of the present invention other thanthose herein described, will be apparent to those skilled in the art bythe foregoing description thereof, without departing from the substanceor scope of the invention. While the present invention has beendescribed herein in detail in relation to its exemplary embodiments, itis to be understood that this disclosure is only illustrative andexemplary of the present invention. Accordingly, the foregoingdisclosure is not intended to limit the scope of the present inventionwhich is defined by the claims and their equivalents.

1. An occlusion clip comprising: an occlusion portion having an uppersingle element occlusion member having proximal and distal upper memberends; a lower single element occlusion member having proximal and distallower member ends, the lower single element occlusion member and theupper single element occlusion member combining to define an occlusionmember plane; a spring portion having a torsion spring connecting theproximal upper member end to the proximal lower member, the torsionspring having a spring height dimension in the occlusion member planeperpendicular to the upper and lower single occlusion members and beingadapted to bias the upper and lower single element occlusion memberstoward a closed position wherein the upper single element occlusionmember is in force contact with the lower single element occlusionmember.
 2. An occlusion clip according to claim 1 further comprising aclip guide portion having an upper clip guide attached to the distal endof the upper single occlusion member, the upper clip guide including afirst planar member having a top upper guide surface and an engagingbottom upper guide surface, the first planar member being perpendicularto the occlusion member plane when the upper and lower single occlusionmembers are in engagement; and a lower clip guide attached to the distalend of the lower single occlusion member, the lower clip guide includinga second planar member having a bottom lower guide surface and anengaging top lower guide surface, the second planar member beingparallel to the first planar member when the upper and lower singleocclusion members are in engagement.
 3. An occlusion clip according toclaim 1 wherein the spring height dimension increases as a rotationalseparation between the single element upper occlusion member and thesingle element lower occlusion member increases.
 4. An occlusion clipaccording to claim 1 wherein the upper and lower single elementocclusion members and the torsion spring are formed from a singlecontinuous wire segment having first and second wire ends.
 5. Anocclusion clip according to claim 4 wherein the wire segment is formedfrom titanium and has a diameter in a range from about 10 mils to about50 mils.
 6. An occlusion clip according to claim 4 wherein the wiresegment is formed from titanium and has a diameter in a range from about20 mils to about 40 mils.
 7. An occlusion clip according to claim 1wherein the torsion spring biases the upper and lower single occlusionmembers to exert a maximum occluding force of at least 0.20 pounds. 8.An occlusion clip according to claim 1 wherein the occlusion portion hasa maximum occlusion width dimension perpendicular to the occlusionmember plane and the spring portion has a maximum spring width dimensionperpendicular to the occlusion member plane, the maximum occlusion widthdimension and the maximum spring width dimension each being in a rangefrom about 10 mils to about 50 mils.
 9. An occlusion clip according toclaim 8 wherein the maximum occlusion width dimension and the maximumspring width dimension are each in a range from about 20 mils to about40 mils.
 10. An occlusion clip comprising: an occlusion portion havingan upper single element occlusion member having proximal and distalupper member ends; a lower single element occlusion member havingproximal and distal lower member ends, the lower single elementocclusion member and the upper single element occlusion member combiningto define an occlusion member plane; a spring portion having a torsionspring connecting the proximal upper member end to the proximal lowermember end, the torsion spring having a spring height dimension in theocclusion member plane perpendicular to the upper and lower singleocclusion members and being adapted to bias the upper and lower singleelement occlusion members toward a closed position wherein the uppersingle element occlusion member is in force contact with the lowersingle element occlusion member wherein the upper and lower singleelement occlusion members and the torsion spring are formed from asingle continuous wire segment having a wire diameter and first andsecond wire ends, the occlusion portion having a maximum occlusion widthdimension perpendicular to the occlusion member plane that is no greaterthan the wire diameter, and a maximum occlusion height dimension in theocclusion member plane that is no greater than twice the wire diameter.11. An occlusion clip according to claim 10 wherein the wire segment isformed from titanium and has a diameter in a range from about 10 mils toabout 40 mils.
 12. An occlusion clip according to claim 10 wherein thewire segment is formed from titanium and has a diameter in a range fromabout 15 mils to about 30 mils.
 13. An occlusion clip according to claim10 wherein the torsion spring defines a maximum interior heightdimension in the occlusion plane when the upper and lower singleocclusion members are in engagement, the maximum interior heightdimension being less than twice the wire diameter.
 14. An occlusion clipaccording to claim 10 wherein the torsion spring biases the upper andlower single occlusion members to exert a maximum occluding force of atleast 0.20 pounds.
 15. An occlusion clip according to claim 10 furthercomprising a clip guide portion having an upper clip guide attached tothe distal end of the upper single occlusion member, the upper clipguide including a first planar member having a top upper guide surfaceand an engaging bottom upper guide surface, the first planar memberbeing perpendicular to the occlusion member plane when the upper andlower single occlusion members are in engagement; and a lower clip guideattached to the distal end of the lower single occlusion member, thelower clip guide including a second planar member having a bottom lowerguide surface and an engaging top lower guide surface, the second planarmember being parallel to the first planar member when the upper andlower single occlusion members are in engagement.
 16. A method offorming an occlusion clip from a single wire strand, the methodcomprising: forming a torsion spring from a first portion of the wirestrand; forming a first occlusion member from a second portion of thewire strand, the first occlusion member having a proximal first memberend connected to the torsion spring and a distal first member end;forming a second occlusion member from a third portion of the wirestrand, the second occlusion member having a proximal second member endconnected to the torsion spring and a distal second member end, thefirst and second occlusion members defining an occlusion plane andhaving a closed configuration in which the first occlusion member is incontact with the second occlusion member and at least one openconfiguration in which the first and second occlusion members arerotated apart within the occlusion plane, wherein the torsion springapplies a biasing force to bias the first and second occlusion memberstoward the closed configuration.
 17. The method of claim 16 wherein theaction of forming a torsion spring includes bending the first portion ofthe wire strand to form a loop.
 18. The method of claim 16 wherein thewire strand is titanium.
 19. The method of claim 16 further comprising:distorting the combined first and second occlusion members and thetorsion spring so that the first and second occlusion members are notcoplanar; rotating the first and second occlusion members toward andthen past one another by a predetermined angular amount, therebyimparting a stress into the torsion spring and connections between thetorsion spring and the occlusion members; returning the first and secondocclusion members to a coplanar condition so that the torsion springbiases the first and second occlusion members toward the closedconfiguration.
 20. The method of claim 16 further comprising: fixedlyshaping the torsion spring into a teardrop shape.
 21. The method ofclaim 16 wherein the wire strand is formed from a metal, the methodfurther comprising: heating the combined first and second occlusionmembers and the torsion spring to a temperature below the melting pointof the metal for a predetermined time period.
 22. The method of claim 21wherein the metal is titanium.
 23. The method of claim 21 wherein thecombined first and second occlusion members and the torsion spring areheated to a temperature is in range of about 600 to about 1600 degreesFahrenheit.
 24. The method of claim 21 wherein the combined first andsecond occlusion members and the torsion spring are heated to atemperature is in range of about 1100 to about 1300 degrees Fahrenheit.25. The method of claim 21 wherein the action of heating the combinedfirst and second occlusion members is carried out in a vacuumenvironment.
 26. The method of claim 21 wherein the action of heatingthe combined first and second occlusion members is carried out in aninert gas environment.
 27. The method of claim 21 wherein the action ofheating the combined first and second occlusion members is carried outin an oxygen environment.
 28. A method of removing an occlusion clipfrom a tissue to which the occlusion clip is applied, the occlusion cliphaving upper and lower single element occlusion members connected by atorsion spring having an outside spring surface and an inside springsurface surrounding a spring opening having an effective springdiameter, wherein the torsion spring biases the upper and lower singleelement occlusion members toward a closed position in which the uppersingle element occlusion member is in contact with the lower singleelement occlusion member occluding tissue and wherein increasing theeffective spring diameter of the torsion spring causes the upper andlower single element occlusion members to separate, the tissue beingdisposed between and engaged by the upper and lower single occlusionmembers, the method comprising: inserting a tapered element into thespring opening and into contact with the inside spring surface; applyinga spreading force to the inside spring surface, thereby causing theeffective spring diameter to increase thereby causing the upper andlower single element occlusion members to separate and disengage fromthe tissue; and removing the occlusion clip from the tissue.
 29. Themethod of claim 28 wherein the tapered element comprises a leg mountedto a pushing surface, the leg being tapered to a larger dimension towardthe pushing surface to which it is mounted such that it will spreadocclusion members as it is pushed further into and through the springopening.
 30. The method of claim 28 wherein the inside spring surface isteardrop shaped.
 31. An occlusion clip applicator for storing andapplying a plurality of occlusion clips each having an occlusion portionwith an upper single element occlusion member having proximal and distalupper member ends and a lower single element occlusion member havingproximal and distal lower member ends, the lower single elementocclusion member and the upper single element occlusion member combiningto define an occlusion member plane and having a maximum occlusionmember width dimension perpendicular to the occlusion member plane, aspring portion having a torsion spring connecting the proximal uppermember end to the proximal lower member, the torsion spring having aspring height dimension in the occlusion member plane perpendicular tothe upper and lower single occlusion members and being adapted to biasthe upper and lower single element occlusion members toward a closedposition wherein the upper single element occlusion member is in forcecontact with the lower single element occlusion member, and a clip guideportion having an upper clip guide attached to the distal end of theupper single occlusion member and a lower clip guide attached to thedistal end of the lower single occlusion member, the upper and lowerclip guides having a maximum clip guide width, the applicatorcomprising: a jaw actuator tube having proximal and distal actuator tubeends and a jaw actuator tube interior; an elongate clip holderconfigured to hold the plurality of occlusion clips, the clip holderbeing formed as a U-shaped channel with a channel interior, proximal anddistal clip holder ends and first and second support rails disposedwithin the channel interior, the first and second support rails beingsubstantially parallel and coplanar and defining a rail gap with a railgap width dimension that is nominally greater than the maximum occlusionmember width dimension and less than the maximum clip guide width, atleast a portion of the channel being disposed within the jaw actuatortube interior; a clip pusher having an elongate support member with aplurality of clip push fingers attached to the support member, thesupport member being mounted such that at least a portion of each clippush finger extends into the channel interior; and a pair of jaws, eachjaw having proximal and distal jaw ends, an inner engaging side and anopposite outer side, a clip slot formed through the jaw from the innerengaging side to the outer side and extending distally from and throughthe proximal jaw end, and a pair of parallel support shelves bounding atleast a portion of the clip slot, the jaws being pivotably mounted attheir proximal ends to the distal clip holder end and being configuredfor engagement by the distal tube end for selective rotation between afully open position and a closed position wherein the engaging sides ofthe jaws are in contact with each other, wherein the clip slot has awidth dimension that is nominally greater than the maximum occlusionmember width dimension and less than the maximum clip guide width. 32.An occlusion clip applicator according to claim 31 wherein the clip slotterminates in an ejection opening adjacent the distal jaw end, theejection opening having an ejection opening width that is greater thanthe maximum clip guide width.
 33. An occlusion clip applicator accordingto claim 31 wherein the jaws each have a pair of ramps bounding aproximal portion of the clip slot, the ramps being aligned with thesupport shelves and the support rails of the clip holder.
 34. Anocclusion clip applicator according to claim 31 wherein the jaws eachcomprise maximum open construction for viewing the occlusion clipthroughout an installation process.
 35. An occlusion clip applicatoraccording to claim 31 wherein the clip push fingers each terminate in aclip push foot configured for engagement with the upper clip guide ofeach occlusion clip so that distal movement of the clip pusher causesthe occlusion clips to slide distally along the support rails.
 36. Anocclusion clip applicator according to claim 31 further comprising:means for selectively moving the jaw push tube in a distal direction toengage the jaws and cause them to rotate from the open position to theclosed position; and means for selectively moving the clip pusher in thedistal direction to cause distal movement of at least one occlusion clipdisposed in the clip holder.
 37. An occlusion clip applicator accordingto claim 36 wherein the means for selectively moving the jaw push tubeand the means for selectively moving the clip pusher are adapted formoving the jaw push tube and the clip pusher in a predetermined sequenceinitiated by a user.
 38. An occlusion clip applicator according to claim31 further comprising: a tube actuator operatively associated with thejaw push tube and the clip pusher and configured to produce selectivedistal and proximal movement of the jaw push tube and the clip pusherrelative to the clip holder.
 39. An occlusion clip applicator accordingto claim 38 wherein the actuator is adapted to produce the distalmovement of the jaw push tube and the clip pusher in a predeterminedsequence initiated by a user.
 40. An occlusion clip applicator accordingto claim 38 further comprising: a rotator attached to the proximal pushtube end, the rotator having a rotator interior in which the proximalclip holder end and at least a portion of the tube actuator aredisposed.
 41. An occlusion clip applicator according to claim 40 furthercomprising: a handle assembly attached to the rotator, the handleassembly having a handgrip with a handgrip interior space and a triggerrotatably mounted to the handgrip, the trigger being operativelyassociated with the tube actuator for selective activation thereof. 42.An occlusion clip applicator for storing and applying a plurality ofocclusion clips comprising: a jaw push tube having proximal and distalpush tube ends and a jaw push tube interior; an elongate clip holderhaving proximal and distal clip holder ends, the proximal end of whichis fixedly attached to a barrel housing, the clip holder beingconfigured to hold the plurality of occlusion clips and being formed asa U-shaped channel with a channel interior, proximal and distal clipholder ends and first and second support rails disposed within thechannel interior, the first and second support rails being substantiallyparallel and coplanar and defining a rail gap with a rail gap widthdimension, at least a portion of the channel being disposed within thejaw actuator tube interior; a clip pusher having an elongate supportmember having upper and lower sides with a plurality of clip pushfingers attached to the lower side, the support member being mountedwithin the jaw push tube interior substantially parallel to the clipholder with at least a portion of each clip push finger extendingdownward into the channel interior; and a pair of jaws, each jaw havingproximal and distal jaw ends, an inner engaging side and an oppositeouter side, a clip slot formed through the jaw from the inner engagingside to the outer side and extending distally from and through theproximal jaw end, and a pair of parallel support shelves bounding atleast a portion of the clip slot, the jaws being pivotably mounted attheir proximal ends to the distal clip holder end and being configuredfor engagement by the distal tube end for selective rotation between afully open position and a closed position wherein the engaging sides ofthe jaws are in contact with each other.
 43. An occlusion clipapplicator according to claim 42 wherein the clip slot terminates in anejection opening adjacent the distal jaw end, the clip slot having aslot width and the ejection opening having an ejection opening widththat is greater than the slot width.
 44. An occlusion clip applicatoraccording to claim 43 wherein the jaws each have a pair of rampsbounding a proximal portion of the clip slot, the ramps being alignedwith the support shelves and the support rails of the clip holder. 45.An occlusion clip applicator according to claim 42 wherein the jaws eachcomprise maximum open construction for viewing the occlusion clipthroughout an installation process.
 46. An occlusion clip applicatoraccording to claim 42 wherein the gap width dimension is sized so thatthe occlusion clips each have a first clip portion that is narrower thanthe rail gap and a second clip portion that is wider than the rail gapthus allowing the clips to be slidably disposed in the clip holder withminimal lateral movement with the second clip portion of each clipengaging the support rails.
 47. An occlusion clip applicator accordingto claim 46 wherein the clip push fingers each terminate in a clip pushfoot configured for engagement with a third clip portion so that distalmovement of the clip pusher causes the occlusion clips to slide distallyalong the support rails.
 48. An occlusion clip applicator according toclaim 42 further comprising: means for selectively moving the jaw pushtube in a distal direction to engage the jaws and cause them to rotatefrom the open position to the closed position; and means for selectivelymoving the clip pusher in the distal direction to cause distal movementof at least one occlusion clip disposed in the clip holder.
 49. Anocclusion clip applicator according to claim 48 wherein the means forselectively moving the jaw push tube and the means for selectivelymoving the clip pusher are adapted for moving the jaw push tube and theclip pusher in a predetermined sequence initiated by a user.
 50. Anocclusion clip applicator according to claim 42 further comprising: anactuator operatively associated with the jaw push tube and the clippusher and configured to produce selective distal and proximal movementof the jaw push tube and the clip pusher relative to the clip holder.51. An occlusion clip applicator according to claim 50 wherein theactuator is adapted to produce the distal movement of the jaw push tubeand the clip pusher in a predetermined sequence initiated by a user. 52.An occlusion clip applicator according to claim 50 wherein the barrelhousing defines a barrel chamber and the proximal push tube end, theproximal clip holder end and at least a portion of the actuator aredisposed in the barrel chamber.
 53. An occlusion clip applicatoraccording to claim 52 further comprising: a handle assembly attached tothe barrel housing, the handle assembly having a handgrip with ahandgrip interior space and a trigger rotatably mounted to the handgrip,the trigger being operatively associated with the tube actuator forselective activation thereof.
 54. A method of applying an occlusion clipemploying an occlusion clip applicator comprising a handle, a trigger, areciprocating jaw actuator, a reciprocating clip pusher having a distaland a proximal position and fingers engaging an upper clip guide, anocclusion clip holder, a stack of occlusion clips disposed in theocclusion clip holder, each clip having a torsion spring section, anocclusion section, and a clip guide section, a clip follower, upper andlower rotatable jaws having an open and a closed position, each jawhaving an open clip track and an ejection element, the methodcomprising: placing the open jaws around a tissue structure; activatingthe trigger to initiate movement of the jaw actuator from a proximal toa distal position thereby rotating the jaws toward the closed position,move the clip pusher from a proximal pusher position to a distal pusherposition, engage the proximal most finger into the clip follower, pushthe clip stack distally, each clip pushing on the proximal end of thenext distal-most clip, the follower pushing on the proximal end of theproximal-most clip, move the distal-most occlusion clip onto the jawswith the upper clip guide engaged onto the upper jaw open clip track andthe lower clip guide engaged onto the lower jaw open clip track, ejectthe distal-most occlusion clip through the ejection elements, andocclude the tissue by the distal-most occlusion clip.
 55. The method ofclaim 54 wherein the follower is constructed of metal or plastic. 56.The method of claim 54 wherein the follower comprises a barrier thatblocks the entrance of the follower into the jaws.
 57. The method ofclaim 54 further comprising: releasing the trigger which results inmovement of the jaw actuator from the distal position to the proximalposition thereby rotating of the jaws to the open position, movement ofthe clip pusher from the distal pusher position to the proximal pusherposition, movement of the clip pusher perpendicular to theproximal-distal movement being minimized by a bias force so that thefingers clear the clips guide section without having to move enough toclear the spring bias section.
 58. The method of claim 57 wherein theclip pusher comprises lateral fingers to engage the clip guide sectionand is U shaped to clear the spring bias.
 59. The method of claim 58wherein the clip guide section on the occlusion clips comprises an upperand lower clip guide each guide having a thickness with the clip pusherengaged with the upper clip guide of a clip in the stack prior to resetand rides upwards over the thickness of the upper clip guide of the clipjust proximal during the reset.